Potential abuse

Knowledge and attitudes towards clinical trials among women with ovarian cancer: results of the ACTO study

https://tinyurl.com/4jacvjs5

 

         Whether or not women understand the nature of clinical trials is a concern for ethics committees and us all. Increasingly women with ovarian cancer are being asked to be participants in clinical trials. Often the women themselves seek to join a trial hoping for better outcomes.

         This survey looked at how well women, with ovarian cancer; understand what a clinical trial involves and what factors were likely to have encouraged them to participate.

         Data from 348 women, who presented with ovarian cancer at one institution, showed that although 80% of them had been involved in trials, only 60% knew what a clinical trial was, 70% understood informed consent and 50% appreciated the concept of randomisation. Almost all of the women reported encouragement from their treating physician as the most important recruitment factor.

         These findings are alarming and show there is obviously a great need for education and improved communication.

Is leak likely?

Risk Factors for Anastomotic Leakage in Advanced Ovarian Cancer Surgery: A Large Single-Center Experience

https://tinyurl.com/2rdb3bxf

 

         Leak of bowel contents after ovarian surgery is an unfortunate side effect of the complicated surgery often required for complete clearance. It is hazardous, with a mortality of about 1%..

         This study looks at the prevalence of bowel leaks after ovarian surgery and seeks to establish what factors make the leak more likely.

         At the one centre of excellence, in Rome, the number of leaks occurring after bowel resection during ovarian cancer surgery was about 3%. The surgery was performed during the period 2011 – 2019 with 515 women affected, of whom 15 had a postoperative leak. Predisposing factors for leak were poor nutrition, low serum protein and surgery to the distal colon.

Obesity, the reality

Anthropometric factors and the risk of ovarian cancer: A systematic review and meta-analysis

 

https://tinyurl.com/5fvxb72r

         It is surprising that the commonly accepted increased risk of developing ovarian cancer in the obese (at about 6%) is less than for other cancers. This study looks at all the available data and partly explains the disparity.

         Using Pub Med and Web of Science databases, information related to more than 27,000 women who developed ovarian cancer, with regard to their weight, was correlated. 

         Results from the study showed the risk of ovarian cancer amongst the obese and overweight was significantly increased for pre-menopausal women (16%), with a larger number than expected of less common types such as clear cell and mucinous. 

         Post-menopausal women who are obese do not have a significantly increased risk of developing ovarian cancer. Because ovarian cancer is predominately a disease of post-menopausal women, the overall risk remains low and supports the World Cancer Research Fund opinion, that the link between obesity and ovarian cancer is probable but not proved.

Death by postcode

Significant variation in treatment and survival outcomes in stage 2–4 ovarian cancer in England: results from the national ovarian cancer feasibility audit pilot 

https://tinyurl.com/2rpytrp7

 

         Sadly it is necessary when thinking about ovarian cancer, to remember how fatal the disease can be. Reduction of mortality and better outcomes are possible with modern care but this depends on optimal treatment.

         This study looks at the death rates for women in the UK, diagnosed with ovarian cancer Stage 2 and above, during the period 2016-2018.  The likelihood of short-term survival was compared to the probability that these women would receive standard treatment with surgery and chemo.

         Overall in the UK 73% of women with ovarian cancer receive standard care. There is significant variation between different population centres with some centres in the UK providing surgical treatment for only 51% of these women. 

         Survival is directly related to the likelihood of adequate care. For women with ovarian cancer who had a high probability of surgery one in eight will die during the two months after diagnosis. Those women less likely to have surgery have a one in seven chance of dying during the same two months.

Endometriosis risk management

Incidence of ovarian cancer after bilateral salpingo-oophorectomy in women with histologically proven endometriosis

https://tinyurl.com/2p8fadwe

 

         Endometriosis cause pain and infertility for many women and also has an increased risk of developing ovarian cancer, with less common types being more frequent for this group of women.

         Women with other causes for increased ovarian cancer are encouraged to have risk reduction surgery with removal of the fallopian tubes with or without the ovaries. Because the ovarian cancers associated with endometriosis are less likely to be the typical epithelial type, it was not known if this approach would work for them.

         With data from the Dutch Pathology Database this study looked at the ovarian cancer rate for more than 7,000 women with endometriosis after tube removal compared with two control groups; one of 42,000 women with endometriosis without surgery and another group of 132,000 women with no history of endometriosis. It is clear that tube removal is protective for women with endometriosis and in fact reduces the risk of ovarian cancer to less than the normal population.